A Memoriam to a Scientist and Visionary in Service of the World: Donald J. Cohen, MD (1940-2001)

Psychiatry begins and ends with our patients—with their diseases and dysfunctions, their biographies and aspirations—which, as a clinical medical science, we must systematically study. Doing that, we will borrow from and pose problems for all the life sciences. New knowledge about how cells and biological systems acquire, code, and exchange information challenges all of medicine.—Daniel X. Freedman, MD, 1992¹

What fascinated me most was how intimate relationships and the desire for being with the other precede the rest of cognitive development, and that this social motivation moves these other achievements forward, including meta-representation and theories about other minds. This intuitive, deeply encoded social orientation is first expressed in the mother's arms and then forms the basis for all future I-Thou relationships.—Donald J. Cohen, MD, 2001²

Donny Cohen, the son of Joseph and Rose from Chicago, Ill, of Moshe and Molly from Berditchev, Ukraine, and Mashie and Avrum from Bialystok, Poland, died early in the morning of October 2, 2001, in New Haven, Conn. Born to and beloved by a family of Chicago bakers, Donald was a rare human being: intellectually gifted yet down-to-earth; playful yet busy envisioning and building a better world; filled with knowledge but always ready to listen, to be taught, and to find solace despite the hardships of life.

By all accounts, by the age of 4 or 5 years Donald was already an expert psychologist, reflecting on the workings of his mind and the minds of his parents, capable of moving from past dialogues to write the scripts of imaginary play, knowing the difference between saying and meaning. By the age of 8 years, he had moved on to experiment on his younger brother, Howard, and to interview socially dysfunctional adults and publish verbatim accounts in his school newspaper.

By age 17 years, Donald had become a philosopher, absorbing the epistemologies of Aurelius Augustine, Rene Descartes, and Ludwig Wittgenstein on how we come to know the mind and intentions of the other. Was it simple observation, a reflex mechanism of the sentient brain, or something to do with the profundity of ordinary language and the density and intensity of interpersonal dialogues?

Donald had immense erudition, but he was dissatisfied with these philosophical accounts. They neglected the earliest moments of parent-child reciprocity. He wanted to know the hows and whys of the shifts in our hedonic homeostasis and how these tides of love enriched our lives with others, our internal sense of well-being, and our relationship with God. Following 4 years at Brandeis University (Waltham, Mass), where he met Phyllis, his wife and lifelong companion, and many of his dearest friends, Donald moved on to Johns Hopkins University (Baltimore, Md), to the University of Cambridge (Cambridge, England), to Yale Medical School (New Haven), to Boston Children's Hospital (Boston, Mass), to the National Institute of Mental Health (NIMH), and to the Office of Child Development in what was then the US Department of Health, Education and Welfare (Washington, DC). During these peregrinations, he pursued his abiding interests in child development, pediatrics, genetics, neuroscience, psychoanalysis, Jewish mysticism, and social policy. Donald's mentors included many of the great figures of psychiatry, psychoanalysis, and child development of the 20th century: Drs Daniel X. Freedman, William Kessen, Ed Zigler, Hans Loewald, Sally Provence, Samuel Ritvo, and Albert J. Solnit.

In 1972 at age 32 years, Donald returned to Yale to join the faculty at the Child Study Center. At the time, he was thought by "very exacting people to know just about everything."³

My first encounter with Donald occurred a couple of years later. I was a fledgling Clinical Associate in the intramural Adult Psychiatry program at the NIMH. Thanks to Elliot Gershon, MD, I was off to central Connecticut with Eleanor Dibble, DSW, to interview and collect blood specimens from members of a bipolar kindred. Eleanor had worked closely with Donald during his days at NIMH and insisted that we stop by the Child Study Center in New Haven to say hello. I remember a bright young man surrounded by an eager group of research assistants who took the time to discuss his interests in autism and something called "Gilles de la Tourette syndrome," an obscure neurological condition characterized by tics and obscenities. I recall his fascination with the sensory urges associated with Tourette syndrome and how these unwanted urges altered the patients' sense of self. He was interested in my background in philosophy and genetics as well as the time I had spent in Egypt, Lebanon, Jordan, and Israel.

I eventually came to New Haven to complete a residency in psychiatry. From those years, I remember most his class on child development and the extended interviews with children and parents that took place with 15 or so residents and other trainees in the same room. These were bravura interviews that seamlessly explored the emerging competencies of the child as well as the images, indeed the portraits, of the child that were to be discovered in the mind of the parent. He also taught us, in these compassionate mental vivisections, that the child's self-portrait is powerfully fashioned by parental imagos, and the fearful consequences when those images are not idealizing.

In 1983, Donald became the Director of the Yale Child Study Center. Under his leadership, the center became internationally recognized for its multidisciplinary programs of clinical and basic research, particularly in the areas of autism and Tourette syndrome. Like his mentor and friend Danny Freedman, Donald was committed to the concept that clinical work enriches and is enriched by research, and that authentic clinical investigation is respectful of the complexity of children's inner experiences and the multiple determinants of their adaptive functioning.

His effective leadership in the worlds of autism and Tourette syndrome has been instrumental in encouraging physicians to listen to patients and their families and for educators, health care providers, and parents to work together to further research and clinical care.

Donald's academic achievements were formidable. He published more than 400 articles and chapters and more than a dozen books. In addition, he served as President of the International Association of Child and Adolescent Psychiatry and Allied Professions from 1992 to 1998. Donald was also elected a member of the Institute of Medicine of the National Academy of Sciences. He greatly enjoyed his role as a Training and Supervising Psychoanalyst at the Western New England Institute of Psychoanalysis (New Haven). He has received numerous awards, including an honorary degree in 1997 from Bar-Ilan University in Ramat Gan, Israel, as well as the Blanche Ittleson Award for child psychiatric research and a Special Presidential Commendation from the American Psychiatric Association. Other awards came in the past year for his contributions to research in autism (Cure Autism Now) and Tourette syndrome (Tourette Syndrome Association Award) as well as the Ruane Prize for Child and Adolescent Psychiatry Research from the National Alliance for Research on Schizophrenia and Depression.

Donald's devotion to both Yale Medical School and the Yale community had a global impact. From his close ties with the Dean, the President of the University, the New Haven Mayor, the Superintendent of Schools, and the Chief of Police, he helped to fashion community-based programs that have now been replicated across the country. Donald's leadership in studies of the effects of violence and trauma on children and families in the United States and abroad has created a worldwide network of collaborators in Italy, France, the Netherlands, the United Kingdom, Germany, Russia, Turkey, Israel, Egypt, Brazil, Chile, China, Taiwan, Japan, and Korea.

Donald especially loved the nation of Israel. He was home when he was in Jerusalem. He loved staying at Mishkanot Shaananim, built by Moses Montefiore in the Yemin Moshe neighborhood just the outside the Jaffa Gate of the Old City. He established programs of research and clinical service and took special joy in fostering the development of gifted young Israeli physician-scientists. Although he was a passionate Zionist, he loved Israel so much that 3 years ago he convened the first meeting of the Middle East Child Psychiatric Association at Sharm el Sheikh, with representatives from Iran, Iraq, Jordan, Lebanon, Egypt, and Israel. He was committed to forging closer ties with the Palestinian people through contacts and visits with various psychiatrists, psychologists, and social service agencies in Gaza and the West Bank. When will we find another like him?

Donald's greatest joy during this past year, indeed the past several years, was to see his grandchildren growing up around him, to be a zaydie—a special, enchanting figure in their young lives. He frequently would come into the center a little late or leave just a bit early to be his playful self with Max, Ariela, and Gabriela and to see the world through their eyes and, yes, to have them see themselves reflected in his loving gaze.

In closing, let me say a few words about the past year. What we discovered was Donald's courage in facing the frailties of the body. He did not slow down; he did not give up. He sought to live in the moment. As Martin Peretz of the the New Republic so poignantly said, "[L]ife kept interrupting his dying."³ He sought to do his work and to prepare us for a future without him, or rather, a future where he is very much within us.

Donald never wrote his treatise, his Philosophical Investigations or his Star of Redemption. In the end, he ran out of time for that. He will be remembered most for his dedication, his intelligence, his smile, his self-deprecating humor, and for his extraordinary gifts as an organizer, physician, teacher, mentor, and friend. He taught us the power of idealization: to look beyond our limitations to what can be achieved through teamwork and sustained effort. His life was his treatise. It was a privilege to know him—so many hours, so so many ideas, so much love. Let us rejoice in the life of this remarkable man by redoubling our efforts—moment by moment—to improve the lives of children in the years to come.